Healthcare Provider Details

I. General information

NPI: 1295699221
Provider Name (Legal Business Name): ASHLEY DIANA ESPERICUETA SEVILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S SPRING ST UNIT 13308
LOS ANGELES CA
90013-3215
US

IV. Provider business mailing address

1131 E PASADENA ST APT E
POMONA CA
91767-5057
US

V. Phone/Fax

Practice location:
  • Phone: 909-329-4141
  • Fax:
Mailing address:
  • Phone: 909-329-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: